Digital Exhaust #192

Amazon’s fine print and digital health’s authenticity problem

Welcome back to Digital Exhaust, a 33c weekly digest. Browse below the button for interesting links, rumors and ephemera coursing through the healthcare ether. As usual, the letter has a tech focus with attention to the human beings that use it.

Amazon’s perversion of the term ‘patient’

This WaPo piece outlines what Amazon Clinic mandates in order for you to be a ‘patient.’ Essentially, as part of the terms of service shrink-wrap, you sign away your privacy in order to upsell other services, target marketing, and train their AI in patient-risk models. It’s all quietly baked in to their ever-expanding extraction architecture.

Your herpes is their win. 

In fairness, if a digital health organization isn’t scraping your behavioral surplus and personal data for the secondary market, they’re doing it all wrong. 

Post-op at home

A Nature NPJ Digital Medicine study looking at the viability of post-op wound management at home.

Despite the desire for more frequent and personalized interactions, the majority viewed the intervention as providing meaningful benefit over routine postoperative care. Remote digital postoperative wound monitoring successfully demonstrated readiness for implementation with regards to the technology, usability, and healthcare process improvement.

…”Despite the desire for more frequent and personalized interactions” — the massive hidden challenge of hospital at home.

Choosing doctors based on who does the most research

A new study in the AAMC’s Academic Medicine demonstrates how residency program directors increasingly value research in their review of applicants. Apparently, these views are shifting as the Step 1 board exam has transitioned to pass/fail.

This, of course, will reward those students privileged enough to take an extra year to fund their own research year. Further, as ‘doing research’ becomes the endpoint for students, choosing those who are deemed ‘researchers’ becomes a less valuable measure. Strathern’s Law: As soon as people change behaviors to alter a measure, it’s no longer a useful measure.

I’ll add that the academic industrial complex has become detached from the challenge of preparing doctors for the epoch shift facing medicine. While the future workforce definitely calls for gifted researchers, we have to as well recognize the need for an entirely new breed of clinical provider. This truth gets little attention, let alone discussion, from those who making selection decisions. 

Once we select them, the way we teach and train physicians is dangerously ossified.

The patient voice meets Big Medical Media

Walters Kluwer is building patient perspectives into their clinical education and knowledge resources, including Up To Date. As one of the world’s largest healthcare publishers, this is a big move. Personally, I never knew about the plight of chronically ill patients until I began following the lives of patients on social media. My medical education failed me here. FierceHealthcare has a quick hit. The WK landing page is here. 

Andreessen on winning in the bot space

Not news, but there’s an arms race around bots. And apparently the golden ring is for us to be less dependent on one another, and more dependent on intelligent code. A16 expands on how to make great bot companions. Check out the last sentence.….bots as our best friends. 

The winners in this space will be the ones who best understand the end users and are able to provide them with a safe, low-friction environment where they can be their unguarded, honest selves. Does this mean our best friends of the future, the ones we share our deepest secrets, goals, and fears with, will be bots? It’s certainly possible. 

Here’s where you should apply the progeny test: Is this what you want for your daughter? How about in their darkest hour, when they’re alone?

And this New York Times (not The Onion) writer spent the weekend with Pi, the latest emotional support bot.

My views were “admirable” and “idealistic,” Pi told me. My questions were “important” and “interesting.” And my feelings were “understandable,” “reasonable” and “totally normal.” 

For the contra view, a nice rundown on why chatbots are not the future via Amelia Wattenberger. The interface here is just beautiful. Check that out, if nothing else. I’d hire her or her person to do my next site…

How the [Bleep] changed television

Pretty interesting Fast Company history of the 1,000 hertz censor bleep.

A quote that resonates with me: Peter Drucker on change and management

Drucker’s 20th century management advice applies perhaps more in 2023. Certainly in healthcare, understanding what needs to stay the same and what needs to change is a central challenge.

Management has to maintain the dynamic equilibrium between change and continuity.

I think I picked this up from The Daily Drucker.

Healthcare's inauthenticity problem

Sachin Jain in Forbes takes on digital health's endemic problem of bullshit propagation. This resonated with me because as someone at the ant’s eye level providing care, all these headlines, acquisitions and press releases add up to a bunch of empty promises.

There are far too many people who take at face value the company declarations of miraculous results—who learn far too late about the epidemic of normalized inauthenticity.

And AI is only making fakery a bigger issue…

What is the future of authenticity?

Excellent essay in Undark from a Stanford professor on the future of authenticity. He describes three kinds of authenticity: historical, categorical, and value-based. Mind blowing that we are now even having these conversations. Never would have imagined this. 

I like to remind folks that going forward we need to keep in mind the power of what I call the carbon touchstone. That is, human face-to-face interaction as the ground truth of all communication. As the nonsense explodes, speaking to someone will quickly become the gold standard of human interaction. 

The Ether Dreams of Fin-de-Siècle Paris

image via the Wellcome Trust

Interesting long-form psychedelic history in The Public Domain Review. 

Those who sipped or sniffed ether and chloroform in the 19th century experienced a range of effects from these repurposed anesthetics, including preternatural mental clarity, psychological hauntings, and slippages of space and time. Mike Jay explores how the powerful solvents shaped the writings of Guy de Maupassant and Jean Lorrain — psychonauts who opened the door to an invisible dimension of mind and suffered Promethean consequences.

Not ‘the good bacteria’

This is my rando share. A popular Japanese hotel has been forced to issue a public apology after it was reported that employees at its cafe fermented a citrus drink by using the bacteria on their own hands. Click through at your own risk.

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